OSA and Atrial Fibrillation

[torontoCPAPguy]

This is far more lengthy a topic and discussion than a single thread is going to be able to do justice to.

First, I just wanted to say hi to everyone and say "I'mmmm Baaaack!". Once my sleep apnea was under control with thanks to many friends on this board it seems that Atrial Fibrillation came to light (to the forefront?) with shortness of breath, chronic fatigue, etc.

I just wanted to say this....

If you have OSA, PLEEEEEZ find yourself a competent cardiologist and get checked out for Atrial Fibrillation.... or just get checked out. Mine was discovered because my wife, during a visit to our family doctor, said "Doctor, he has his OSA under good control but he is still short of breath and tired during the day. Can we do a ECG?" The family doctor did an ECG (for the umpteenth time) and pronounced it normal. My wife asked if he would send it off to a cardiologist for a second look and the family doctor did so.

I got a call the next day and was in to see the cardiologist within 48 hours. I had Atrial Fibrillation. That was over a year ago. After messing around for a year I entered hospital in December 2011 and was started on a drug called TIKOSYN. Titrated the dosage and monitored. Electrocardioverted and have been in Normal Sinus Rhythm since December 2011.

I no longer have the shortness of breath but still awaken groggy and it takes an hour or the better part thereof to clear my head. A coffee might help, but it is a bad trigger for aFib.

Be aware of this. There are a few key links to aFib. On the top ten list is: Diabetes, Thyroid issues.... and Obstructive Sleep Apnea! On the top ten list.

So, if you have OSA, you MUST take care of it. And you MUST get checked out for Atrial Fibrillation during your physical or sooner. aFib can be a progressive affliction and mine had progressed from 'intermittent' to 'chronic' to 'permanent' in the course of less than three years at most. I am now on a wonderdrug, if you can tolerate it, called TIKOSYN (Pfizer), and am in Normal Sinus Rhythm for over three months. The difference is HUGE.

And I would not spend a single night without my S9 and infused oxygen. If you think OSA is a pain in the arse, just wait until AFIB rears its ugly head. You will think that OSA was a walk in the park.

And here is the punch line kiddies........ the high blood pressure spikes that occur during OSA events are going to kill you dead. Make no mistake, this is something that needs your urgent attention.

I am also supplementing with Magnesium, Potassium, Taurine, CoEnzyme Q10 (Ubiquinol) and a host of vitamins. More energy than I have had in 4 years. And I feel generally a whole lot better than I have in four years. Getting the aFib under contol was key.

So, the bottom line? If you think your OSA is under control but are still awakening groggy and are tired during the day? Chances are that it could be Atrial Fibrillation. Chances are GOOD!

Just my two cents worth and take it all with a grain of salt.

Glad to be back.

[chunkyfrog]

Coffee? Aw, poop!

[MaxDarkside]

I have arrhythmias and recently was put on a 24 hr Holter monitor to see if I had A-Fib. They missed the big "flutters" (poo) but I felt only 3 small ones but they said I had 9, mostly PVCs (premature ventricular contractions) and PACs (premature atrial contractions), rather benign. I had a "big one" (likely ventricular fibrillation) last Summer which nearly killed me. Well, if they had found A-fib on the monitor the Dr. said he'd put me on "rat poison" (Warfarin) to avoid clotting that can occur during A-Fib.

[Slinky]

I was having strong, erratic heart beats about once a month. And prior to that gentle heart flutters even less often for about a year previous. Yeah, I'd be tired; we were working on "tweaking" and "polishing" my PAP therapy and I have COPD so what's to be surprised about SOB and tired? My family doctor suggested a Holter monitor but I saw no sense in going to the trouble and expense given how infrequently they occurred. I mean, what were the chances of catching an episode??

Then whilst sitting at the snack bar watching Jeopardy or Wheel of Fortune I gradually realized I was SOB, I mean REALLY SOB! And then it felt like something was wrapped tightly around the base of my throat. And then my chest started hurting. Really hurting. And heart was racing. Hubby was outside somewhere and 02 was upstairs. 02 seemed the wiser choice. Long story short, when it continued despite 02 and an aspirin I called 911. Poor hubby had NO IDEA when the ambulance pulled into the yard! I"m not sure hubby has forgiven me for that scare even now after all this while.

Trip to ER and Dx of A fib and a script for coumadin and cardizem. A 30 day event monitor was ordered. Managed to have 2 A fib events whilst on the monitor. And encountered edema w/the cardizem so switched to Torodol and Rythmol added. The Torodol is to slow the heart rate, the Rythmol to regulate the heart rhythm. I haven't had an A fib event since the 3rd day of Rythmol. Its been over a year now. Just finished up a 21 day event monitor recently w/no events. Cardiologist will order another in August and if no events during that one either we can consider discontinuing the coumadin. I've been pushing him to try the "pill in a pocket" approach but he's not too receptive to that just yet. But I haven't given up on that yet either. Good things come to he/she who waits. *wicked grin*

[Kody]

Wow interesting timing of this thread. I just came from the ER a couple hours ago. Out walking the dogs and my heart started fluttering, and then racing wildly. Last time this happened a month ago, they told me on the phone to come in if it happens again. I did, they did an EKG and it was normal. However I have had those PAC's before as well, but never with the heart racing stuff. She said it could be possibly Supraventricular Tachycardia, (SVT); or Atrial Fibrillation. Wouldn't know for sure unless I wore one of those monitors and it happens. Have been VERY tired feeling the last few weeks as well, even with good numbers. Humm.. Maybe I should get this checked further, thanks for the info.

[Slinky]

By all means, Kody, do have the 30 day event monitor to enhance the chances of catching any arrhythmias. If it is a CardioNet event monitor you might want to speak up about a different company. My insurance is refusing to pay for the CardioNet saying it is experimental. Yet they paid for my eCardio event monitor last year w/no problem. Whilst all are similar they are different enough .... I've heard of others whose insurance won't pay for the CardioNet MCOT event monitor as they consider it to be experimental.

[MaxDarkside]

I've heard of others whose insurance won't pay for the CardioNet MCOT event monitor as they consider it to be experimental.

Cost... I think it's the cost. My wife had a cellular monitor, I think it was these guys (not positive) and I did see the bill go by... it was THOUSANDS of dollars (yes, plurality of thousands). There was an issue with whomever the vendor was vs. the hospital vs. insurance and we were never billed again. Some sort of significant cat fight went on behind the scenes and it was all dropped, in the end.

[torontoCPAPguy]

I have arrhythmias and recently was put on a 24 hr Holter monitor to see if I had A-Fib. They missed the big "flutters" (poo) but I felt only 3 small ones but they said I had 9, mostly PVCs (premature ventricular contractions) and PACs (premature atrial contractions), rather benign. I had a "big one" (likely ventricular fibrillation) last Summer which nearly killed me. Well, if they had found A-fib on the monitor the Dr. said he'd put me on "rat poison" (Warfarin) to avoid clotting that can occur during A-Fib.

If your doctor has not taken any affirmative action in regards to PVC's and PAC's time for a new doctor.

Trying upping your Magnesium intake, supplementing as necessary. Very slowly increase from 100mg/daily to 500mg/daily as your bowels tolerate it. Magnesium Glycinate (chelated/albion process) http://www.iHerb.com

When you have reached 200 or 300 mg daily, start taking Potassium Gluconate (Now Brands powder is 1 tsp = 540mg Potassium) and drinking low sodium V8 to get 4-5 GRAMS of Potassium into your system. Your family doctor can test your serum Potassium and it should be in the 4.5 range. Serum magnesium tests are not really valid and you need to take an intracellular magnesium test like EXATEST (http://www.exatest.com) to determine magnesium levels.

I have chronic aFib and am on TIKOSYN 500ucg. b.i.d. (Pfizer.com) but have breakthrough aFib if my Potassium falls off. Had it last night.... seems to come at me towards bedtime for some reason. Drank some LS V8 with a teaspoon of Potassium Glycinate mixed in and 30 minutes later it was gone. Ditto the PAC's and PVC's.

Give it a try and let me know how it works for you. If you visit http://www.aFibbers.net you will be able to do a search on PAC's and PVC's and Sodium/Magnesium. There are also lots of reference papers online for your edification. Read the one on supplements and the 12 step cure for aFib (not really a cure for all but it certainly helps bigtime).

Living with PAC's and PVC's may be an indicator of heart troubles to come, like aFib. I would not waste time in getting it looked after or your left atrium will enlarge making it even more difficult for your heart to pump a full load of well oxygenated blood to your extremities and vital organs.

FWIW. Been there. Done that. Got the T shirt already.

[torontoCPAPguy]

Asides from a Holter Monitor, frequent and repeated ECG's are in order; the latest machines will detect arrhythmias and print across the strip in red what they are seeing. A current top notch ECG will print ATRIAL FIBRILLATION or ATRIAL FLUTTER on the strip of detected so that even your family doctor can tell.

Also, there are other symptoms of aFib that can be seen on thorough examination. Firstly, I would get your family doctor to refer you to a TOP NOTCH cardiologist/electrophysiologist (see aFibbers.net for the who is who). One who has dealt with thousands of cases is a good thing. One thing they will look for is enlargement of the left atrium/ left atrial appendage.

You want to deal with this thing as early as possible as aFib begets aFib... it goes from once in a while, to lots of times, to permanent or chronic 24/7/365, which is what I had.

The bad news is that aFib will indeed leave you tired and listless as your organs are not being oxygenated. The really bad news is that it will eventually start to degrade your heart and lead to heart failure, stroke, etc. If you happen to be diabetic as well, you are headed towards having toes amputated as your diabetes is already working on those arteries and veins and capillaries.

aFib is tricky in its earliest stages. You MUST advocate for yourself.

[MaxDarkside]

If your doctor has not taken any affirmative action in regards to PVC's and PAC's time for a new doctor...Give it a try and let me know how it works for you. If you visit http://www.aFibbers.net you will be able to do a search on PAC's and PVC's and Sodium/Magnesium. There are also lots of reference papers online for your edification. Read the one on supplements and the 12 step cure for aFib (not really a cure for all but it certainly helps bigtime).

Thanks. I'll go read and learn more and maybe take some actions as you suggest.

Living with PAC's and PVC's may be an indicator of heart troubles to come, like aFib.

I've had some sort of "Significant Arrhythmic Event" (probably v-fib) and I had hoped that xPAP would eliminate my arrhythmias but no. I am trying to lie to myself, in denial, that I could have that "Significant Arrhythmic Event" again and this time not get up and walk away, so I will take your advice and learn further.

Thanks.

[MaxDarkside]

Trying upping your Magnesium intake, supplementing as necessary.... start taking Potassium...

Since I take HCTZ which is essentially a "mineral flusher", I probably deplete on a lot of metals. I'm tested every so often, within tolerance, but this is maybe one reason I CRAVE raw spinach salads with salsa, pepperoncini, a dash of shredded cheese (Magnesium, Potassium, Calcium, ...). I may remain in tolerance on my metals because I eat such a salad often. I also crave protein, I don't know why, but I think hard a lot in my job, maybe I'm always rewiring neural pathways (wink).

[FarmGirl]

A bit off topic, but the nurse in me requires me to say something.......

V-Fib is a LETHAL arrhythmia! The heart is doing nothing but quivering and is not circulating blood. The only cure for this arrhythmia is DEFIBRILLATION (electric shocks) and that doesn't even work all the time. If it's not treated, your loved ones will find out how good your life insurance is.

If you are having V-Fib, you are clinically dead (if you are still talking during this rhythm, then it's not v-fib). I hope you are with someone who knows and will use CPR and call 911 immediately.

/off my soapbox........

[chunkyfrog]

Good point, FG, although atrial fibrillation is the concern here.
Can A-fib convert to V-fib?
We have heard that A-fib may convert to normal on its own, but often needs intervention.
I do not know.

[MaxDarkside]

A bit off topic, but the nurse in me requires me to say something.......

V-Fib is a LETHAL arrhythmia! The heart is doing nothing but quivering and is not circulating blood. The only cure for this arrhythmia is DEFIBRILLATION (electric shocks) and that doesn't even work all the time. If it's not treated, your loved ones will find out how good your life insurance is.

If you are having V-Fib, you are clinically dead (if you are still talking during this rhythm, then it's not v-fib). I hope you are with someone who knows and will use CPR and call 911 immediately.

/off my soapbox........

Correct. I was likely clinically dead, at least from a cardio stand point. My internal medicine doctor calls me a "Flat Liner", my neurologist is pleased he can speak to me. I knew my heart had stopped or was quivering because I could feel my heart back-filling with blood. Inflating like a balloon, it was a very strange sensation as all went white. I was alone, but I fought back with all my might as I lost consciousness and self resolved probably from a jolt of massive adrenaline, probability of about 0.0001. People do self resolve from V-Fib, tho rare. There are actually people that have a very rare condition where they have V-Fib daily, always self resolve, it's very weird. Thank God I don't have that.

[FarmGirl]

Yes, I realize the topic is a-fib. I think some are interchanging it with the v-fib which is totally incorrect.

Can a-fib convert to v-fib? Honestly, any rhythm can convert to v-fib given the right circumstances. The clots which form during a-fib can cause heart attacks and strokes.

And yes, a-fib can convert back to RSR with no intervention, but that is generally rare. Once a-fib has occurred, the likelihood of reoccurrance is much greater..... to the point of a permanent rhythm change to the much less effective (and more dangerous) a-fib.